Patients skipping waiting room in favor of visiting doctor online

NAPLES, Fla. - Patients someday might skip the waiting room to see their doctor by a video visit.

The prevalence of telemedicine interaction between medical providers, or between doctors and patients in remote settings, is expected to move into the mainstream. It could include using Skype or some other video system between doctors and patients for a new generation of house calls.

"Most office visits don't need to be face to face," said Dr. Allen Weiss, president and chief executive officer of the NCH Healthcare System in Florida. "Instead of someone running for an office visit, a quick electronic visit can take less time."

The widespread use of electronic medical records is making technology-based interaction between doctors and patients possible, where a relationship between the two parties already exists, where patient privacy is certain, and when the matter at hand is not a medical emergency, industry officials say.

The Washington, D.C.-based American Telemedicine Association estimates half of all U.S. hospitals already use some form of telemedicine to monitor patients' vital signs and cardiac rhythms to keep them healthier and out of hospitals.

Home health agencies use telemonitoring for homebound patients, and some mental health professionals were early adapters of audio and video visits with patients for medication management and behavioral therapy.

What will help spur greater use of telemedicine and video-based visits is a new reimbursement structure that is no longer based on payments for each patient visit, Weiss said.

The development of new networks among hospitals, doctors, and other medical entities into accountable-care organizations, ACOs, is the mechanism by which these groups will be paid one fee for a patient outcome. The move toward ACOs is part of the Affordable Care Act to be more efficient and outcome-focused.

The Mayo Clinic is piloting video visits and a decision will be made later this year to determine whether it's practical and beneficial to expand it, said Bob Walters, with Mayo Clinic Florida in Jacksonville.

"The lion's share of information about a patient is done with the e-consult. What isn't available is the visualization of patients, and that is where you take it to the next level," Walters said.

The patient for the video visit would be in an examination room so the Mayo doctor could ask the patient to walk or some other physical movement.

"The technology has improved to the point where it is more practical to look at valuable solutions going up the care level, to more specialized care," Walters said. "It is in everybody's best interest to minimize the travel of a patient."

Insurance companies are coming on board with video visits and the growth of ACOs will drive it more, he said.

"There's no incentive to have the patient come back to (a doctor's) office unnecessarily," he said. "The commitment of ACOs is to manage costs."

The state Medicaid program covers telemedicine for behavioral health services and for visits between doctors and patients when the technology allows real-time, two-way communication, said Shelisha Coleman, a spokeswoman with the state Agency for Healthcare Administration.

Commercial insurers are covering telemedicine services to a varying degree. Jacksonville-based Florida Blue reimburses physicians for electronic consults as long as the patient information is protected, according to Kevin Tincher, senior manager of network operations. To date the volume has been low, he said.

United Healthcare, based in Minnesota, in 2010 launched online services, called NowClinic, to provide people with access to physicians anytime for 10-minute medical sessions by secured live chats, by phone or webcam without an appointment. NowClinic isn't available in Florida and a company official couldn't say if it will be in the near future.

The Lee Memorial Health System in Lee County uses telemonitoring for patients in their homes after they've been discharged from the hospital, but it hasn't started anything like video or real-time visits between clinicians and patients.

"It's definitely where we are going to wind up," said Mike Smith, chief information officer at Lee Memorial Health System in Lee County, Fla. "We will see more care moving into the home and where you are able to connect your family member to your electronic medical record. I don't know when we will do video visits. We are evolving into it."

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